Children And Anorexia: Noticing The Warning Signs

We're going to switch gears now to our weekly parenting conversation. And we know for some, this will be a painful conversation. But that's why we turn to our diverse group of parents every week for common sense and savvy advice in dealing with painful issues. Today, we want to focus on eating disorders. Now stories about celebrities with unhealthy eating habits are often in the news. The issue is in the news again because of the finale recently of the NBC reality show "The Biggest Loser." The winner Rachel Frederickson won the competition weighing in at 105 pounds after losing nearly 60 percent of her body weight.

And that's caused a number of observers to question, as they often have on that show, whether the show is promoting unhealthy methods and too rapid weight loss. As well, the pop star Ke$ha recently canceled tour dates, acknowledging that she will continue treatment for an eating disorder. But out of the spotlight, thousands of American families are struggling with these issues. An estimated half a million teenagers have an eating disorder. And according to the National Institute of Mental Health, this is the deadliest form of mental illness. So you can see why we wanted to talk about this. And we've called Dr. Leslie Walker. She's a pediatrician and chief of adolescent medicine at Seattle Children's Hospital. Dr. Walker, welcome back. Thanks for joining us again.

LESLIE WALKER: Thank you for having me.

MARTIN: And Leslie Morgan Steiner is one of our regular parenting contributors. She struggled with an eating disorder herself as a teenager, And she's now the mom of three children. Welcome to you back. Welcome back to you as well.

LESLIE MORGAN STEINER: Thanks, Michel.

MARTIN: So, Dr. Walker, could you remind us of what actually qualifies as an eating disorder?

WALKER: Well, you know, a lot of kids have, you know, media influences, and they worry about their weight and how they're exercising and how they look. But a kid who has an eating disorder, someone who really has gone well beyond that that they're either restricting their food severely, they're purging, meaning they're exercising excessively or they're, you know, regurgitating their food, trying to lose weight. But they don't really have a goal - an end point. They usually have a lot of fear about food and a lot of body distortion. And it really causes a lot of angst and stress within the family.

MARTIN: You know, Leslie Morgan Steiner, you know, one can say, look, I can understand why a pop star who's in the public eye and has to appear on stage, usually in, you know, skimpy garb or tight garb, would feel a lot of pressure to look a certain way. But you were not that. So what was the appeal? And you wrote about this recently, I have to say, in a really vivid way that helped me see it. But can you help us understand what was the appeal of this for you?

STEINER: Well, I was a senior in high school. I was heading off to college. I was - there was a lot of change going on in my life, and I was terrified of all of it. And to me, I wanted to lose weight because maybe every teenage girl wants to lose weight. But what I loved about it is that it made me feel in control of my life. And it also made me feel really special and really kind of invincible. I was old enough to know that I was never going to be the smartest, the prettiest, the fastest, you know, all those superlatives. But I thought, you know what? I have a chance of being the thinnest. And it made me feel great every single day as I - during the summer as I got ready to go off to college. And by the time I left for school, I had gone from weighing 130 pounds to weighing 90 pounds.

MARTIN: And were you getting a lot of positive feedback for this, even though - look, I've seen pictures from that time. Your bones were sticking out. I mean, you could, at one point, you could even feel your liver.

STEINER: Right.

MARTIN: I mean, were you getting, like, positive reinforcement for this from people?

STEINER: At the beginning I got tons of positive reinforcement, and I liked that. But I tell you that the thing that mattered the most to me was my own positive reinforcement. I loved how thin I was getting. And even when my older sister who I adored told me to stop, you know, that I didn't look good anymore, and people started staring at me on the street, it didn't matter to me 'cause I still thought I looked great. And I have to say, even though I looked frail and terrible, I felt really strong and powerful. It's one of the most seductive things about anorexia is that it makes you feel really tough and great because of what happens to your brain chemically when you're starving yourself.

MARTIN: Dr. Walker, you know, we often think of teenage girls, as Leslie was, as the main people who are participating in this. But you say you are seeing girls and boys - and boys - as young as 8 or 9 who are experiencing this. In fact, a mother just wrote a piece about - for Salon - about realizing that her 9-year-old was going through this. So can you - Dr. Walker, can you tell us, like, why? And is this something new?

WALKER: No. I don't think it's something new. But, yes, I've had kids as young as 8 and 9, boys and girls, who are clearly restricting their food to lose weight. And, you know, if you look at it, kids between 9 and 10 years old, there's a big jump in kids being afraid to be fat. I mean, kids about 9, maybe half of them in the country, when they're surveyed, say they're worried about being fat or feel like their body doesn't look well. It jumps up to almost 80 percent when you hit 10-year-olds.

And it makes sense in the sense that this is when kids are beginning to look different. They're going through puberty. Some kids are getting bigger. Some kids, you know, are staying smaller. And kids at that age are beginning to compare themselves with their friends and with the media and say am I normal. And for some kids who are more set up to have this kind of a disorder, they think, I'm not normal, and I'd better start losing weight.

MARTIN: So, Leslie, let's use the time that we have left to talk about how you can counteract this. I mean, you wrote a piece about this, and you were very blunt about some of the things that you think people should do. Could you just start us off?

STEINER: Well, I want to say, I speak from the perspective as a survivor myself but also as the mother of three kids, a boy and two girls. And they all went through this kind of period of body distortion. I think the most important thing is to not ignore it when your kid says I'm fat or whatever it is that he or she says. What kids want so much is a reality check from their parents. And if your child is big, which my kids are, it was so relieving to them when I said, you know what? You're not a little twig like some of your friends. You're beautiful, but you're bigger. And I said, I'm bigger, too. I always have been. And they want a reality check. So don't dismiss it. Don't just laugh and say no, you're not.

Take it seriously. I also think it's really important to complement kids at this stage even excessively. I mean, I tell my girls and my boy all the time, you know, whenever I have the opportunity about how they look - they look great. Or, you know, you look so strong. I even - you know, use the intimacy of the parent-child relationship. I say, god, your legs are gorgeous, or look at those muscles. Or - you know, to just lay it on really thick 'cause I think we forget that kids need that so much. They need that positive reinforcement. And then I also think it's really important to have radar for it, to look for it. My kids started going through this at 8, which is a shock. It seems so young. But it does happen. Be aware of it. Don't dismiss it. And talk to your kids about it.

MARTIN: Dr. Walker, do you want to pick up the thread here? What are some other things that you're seeing from your side of it that you think would have helped?

WALKER: I think also - I think everything she said is right. And also, empowering your child to take steps to have a healthy life - to sleep well, to eat well, to have some kind of physical activity to really give them power in other areas of their life where they can feel like they are taking control and growing up and being successful. I think that helps take the attention off of doing some unhealthy behaviors.

MARTIN: So maybe if they want to do the purple hair, let them do the purple hair. Maybe you could - Leslie's looking at me - no. She's like, no. But, Dr. Walker, do you feel that there is a role for, you know, friends and neighbors, you know, perhaps, the, you know, the cool aunt. I mean, one of the things that I was - interesting - we talked to a mom a couple of months ago whose daughter had the opposite issue.

She felt her, you know, her daughter was kind of a compulsive eater. And it was interesting how much blowback she got from it when she tried to regulate her daughter's eating and say, no, you can't have a second cupcake, how many people would say to her, oh, you're mean. It seems like people get all kinds of mixed messages. So I'm wondering, should outsiders play any role in this, or should they just stay out of it? What do you think?

WALKER: I think, you know, kids grow up in a village and everybody really has a role to play in helping support them to be as healthy as they can be. And I think negative reinforcement in any way usually doesn't work. So really, positive reinforcement in helping kids see the positive parts of who they are and what they can do is always going to be very important from everybody that comes into contact with the kid. So really watching language. Not saying - you know, when somebody says, I need to have a diet. I need to go on a diet. Not finding them a diet to go on, but then - but rather helping a kid understand what is healthy and how they are doing well with what they are doing and how they can continue to work on some of the positive things they're doing.

MARTIN: Leslie, we only have about a minute left. Is there just one thing, as a survivor yourself, that you would really want people to know, and especially when they read stories about the ones we just talked about like Ke$ha saying, you know, I'm struggling with this? Is there something we really don't get that we need to get about this?

STEINER: I think that it's really hard to understand from the outside how appealing it is to somebody to control their body and to control their food, whether it's through being bulimic or anorexic or over exercising. And, you know, you think it's just so easy. You know, people say things like, well, why don't you just, you know, eat a candy bar, or, you know. People don't take it as seriously as they should. It is a devastating illness. And once it gets a hold of you, it's hard to let go. So I think that parents and family members should take it seriously and not shame anybody who is experiencing it.

MARTIN: Leslie Morgan Steiner is one of our regular contributors to our parenting conversations. As we mentioned, she's a survivor of an eating disorder as a teenager. She's now the mom of three children. Dr. Leslie Walker is with us, and she's a pediatrician and chief of adolescent medicine at Seattle Children's Hospital. And I thank you both so much for speaking to us.